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Which Numbers Should a Practice Owner Actually Watch? A Consultant’s Five Vital Signs

Kiera Dent had a client she knew only as “iPhone” — a doctor who joined her virtual summit without ever renaming his device on screen. iPhone had just bought a practice, knew nothing about ownership, inherited a seasoned team steering the culture somewhere he didn’t want to go, and delivered the sentence that stops her cold every time she hears it: “Kiera, I’m not even taking home a paycheck.”

Two years later he’s producing $250,000 a month, up from $150,000, running a 40 percent profit margin, sitting next to an office manager who says he makes her feel seen — and asking how he can coach other owners through what he survived.

Dent is the Owner, Founder, and CEO of Dental A Team, and her consulting practice was built on her own version of that story: she started in dentistry as a teenage dental assistant, worked every front-office seat, and then helped one of her dental-school students open a practice in Colorado that grew from $500,000 to $2.4 million in nine months. Success on paper; behind the scenes, her health and marriage were coming apart from 2 a.m. workdays. The Dental A Team is everything she wishes someone had handed her then. We had her on the Dentelligentsia podcast, and her energy does not survive transcription — but her numbers do.

The five vital signs

Dent calls KPIs the vitals of a practice — the blood pressure and temperature that tell you where the broken system is before you waste a year fixing the wrong one. Asked for the short list, she gave five: production, collections, overhead, new patients, and case acceptance — with reappointment percentage as the sixth she can’t leave out.

Then she gave the working details that separate real tracking from a dusty dashboard. Collections should run at 98 percent of production — plenty of practices produce beautifully and quietly fail to collect, and the money is sitting in accounts receivable, patient and insurance both, waiting for someone to ask why. Diagnosis feeds everything: the benchmark is diagnosing three times what you want to produce, because you can’t accept treatment that was never presented. Case acceptance gets measured dollar-for-dollar — of the $1,000 presented, how much was accepted? — not by a feel-good yes rate. Hygiene should produce three times a hygienist’s pay in a PPO practice, four times in fee-for-service, and always measured on adjusted production, not gross. Her line for that one belongs on a sticky note: “Gross feeds the ego. Net feeds the family.”

And the doctor shouldn’t be compiling any of it. The team tracks; a report lands on the owner’s desk weekly or monthly; the owner reads, asks why, and adjusts. Her deeper point is that this is what makes ownership bearable: the numbers aren’t a report card, they’re a treasure map — they tell you which system to fix and whether the fix worked.

Systems that don’t require remembering

Dent’s rule for fixing whatever the numbers flag: “Teams gravitate toward ease. Everything we implement should be easy.” A true system, in her definition, is one nobody has to remember — the note template that won’t let a claim go out incomplete, the report that runs itself, the handoff printed on the route slip so the front desk hears the same words every time. Her models are McDonald’s and Chick-fil-A: identical experience at scale, achieved by process, not heroics — and not by hoping and praying a team member doesn’t drop the ball.

The handoff example is worth the whole section. One practice she worked with was converting 25 to 30 percent of treatment; the day her team rebuilt the handoffs — everyone speaking the same language, the patient walking to the front desk saying “Doctor wants to see me back in two weeks for a crown, for an hour” — they closed 100 percent of cases presented. Same dentistry. Different sentence.

On the patient side of that sentence, two more Dent rules. Figure out each patient’s actual driver — function, longevity, appearance — because after asking thousands of patients, “99 percent of the time, it’s not cost.” And speak plainly about severity: her hygienist-consultant’s phrase is “never use little-league words for major-league problems.” A bombed-out tooth described as “a little cavity” doesn’t spare the patient; it just guarantees they won’t treat it. Patients, she says, aren’t buying the treatment. They’re buying your confidence — delivered with the follow-up she scripts everywhere: “The good news is, here’s how we’re going to get you back to healthy.”

When to bring help — and what it should return

Dent’s client base runs about 75 percent acquisitions, and she’s candid about why she loves them: the patient base exists, so her job is “Miracle-Gro.” She’s equally candid about what every new owner should expect, no matter how good the deal: the six-month shakeout. Costs high, systems foreign, patients deciding whether to stay — “as soon as you buy a practice, it is bananas for six months. That’s when you need someone to pull your head out of the sand and say: step one, step two, step three.”

Which drives her timing advice: the owners who do best bring the consultant in a month or two before the doors open or the deal closes — often baked into the loan — rather than calling mid-drowning. And her standard for any consultant, including herself, is refreshingly commercial: the fee should come back several times over. “Be intentional with what you’re purchasing — buy the things that put money on your books.” Her firm targets two to five times its fee in added production and reduced overhead. If a consultant can’t describe how they’ll do that, keep interviewing.

Culture is a slow, consistent burn

The team section of the conversation could fill a book, so here are the rules we kept. Payroll should run around 30 percent of collections, excluding the doctor — and show your team the total compensation number once or twice a year, because nobody counts benefits and payroll taxes in their head. For a startup, hire the expensive office manager who’s strong at everything you’re weak at — and never staff the front office with just one person, both for coverage and because Dent has seen too much embezzlement to leave one set of hands on all the money.

Hire complementary personalities, not clones — the bubbly scheduler and the detail-obsessed biller are different species and should be. Anchor everything to three core values that actually came from you (hers: do the right thing, have fun, make it easy), put them in the job ads, and shout them out weekly. Hold the line her favorite quote draws: “The worst thing you can do to your best employees is tolerate the poor performance of your worst employee.” And get good at the conversation that fixes it — “a conversation, not a confrontation” — because, in the line she’s amended to fit her life, your success and happiness are directly proportional to the number of uncomfortable conversations you’re willing to have. Sometimes the ending is her gentlest phrase, deployed after years of practice: send them away with love. A first hire is never a forever hire, and that’s nobody’s failure.

The two waves coming: DSO offers and AI

Her doctors report DSO offers arriving three and four a day, and her counsel isn’t anti-DSO — it’s anti-emotional-decision. Every hard day in dentistry makes an EBITDA multiple look like rescue. Her client “Hometown” nearly took $5 million for a practice her block scheduling showed would produce $5 million the following year — with ten years of career left. Know your endgame number before the offer arrives, and never sell on a bad day.

On AI, her prediction is specific: the clinical side stays human for now; the front office transforms first. Billing, claims, phones, scheduling — she considers those already in AI’s path, and one pediatric client has an in-house bot named Amy answering patient communication alongside a team of virtual assistants. Radiology tools like Pearl and Overjet are already changing diagnosis conversations, and she suspects the insurance companies are ahead of the practices. Her advice: add one AI tool this year — be second or third to innovate, not last.

Her best advice ever received doubles as the practice-ownership thesis: don’t lose money. “Businesses should produce profit. You should be making more than you made as an associate — otherwise, go be an associate.” Paired with the Go-Giver principle she built the firm on — always give more value than you receive — you get the whole model in two sentences.

The full conversation with Kiera Dent, “How to Build a Thriving Dental Practice with practice management expert Kiera Dent,” is on the Dentelligentsia podcast. And when the numbers say the practice has outgrown the walls — talk to us.

And follow Kiera Dent on Linked In or check out the Dental A Team website.